Previous studies in a high-income country have demonstrated that people with and without low back pain (LBP) have an implicit bias that bending and lifting with a flexed lumbar spine is dangerous. These studies present two key limitations: use of a single group per study; people who recovered from back pain were not studied. Our aims were to evaluate: implicit biases between back posture and safety related to bending and lifting in people who are pain-free, have a history of LBP or have current LBP in a middle-income country, and to explore correlations between implicit and explicit measures within groups.
Exploratory cross-sectional study including 174 participants (63 pain-free, 57 with history of LBP and 54 with current LBP). Implicit biases between back posture and safety related to bending and lifting were assessed with the Implicit Association Test (IAT). Participants completed paper-based (Bending Safety Belief [BSB]) and online questionnaires (Tampa Scale of Kinesiophobia; Back Pain Attitudes Questionnaire).
Participants displayed significant implicit bias between images of round-back bending and lifting and words representing “danger” (IATD-SCORE: Pain-free group: 0.56 (IQR=0.31–0.91; 95% CI [0.47, 0.68]); history of LBP group: 0.57 (IQR=0.34–0.84; 95% CI [0.47, 0.67]); current LBP group: 0.56 (IQR=0.24–0.80; 95% CI [0.39, 0.64])). Explicit measures revealed participants hold unhelpful beliefs about the back, perceiving round-back bending and lifting as dangerous (BSBthermometer: Pain-free group: 8 (IQR=7–10; 95% CI [7.5, 8.5]); history of LBP group: 8 (IQR=7–10; 95% CI [7.5, 9.0]); current LBP group: 8.5 (IQR=6.75–10; [7.5, 9.0])). There was no correlation between implicit and explicit measures within the groups.
In a middle-income country, people with and without LBP, and those who recovered from LBP have an implicit bias that round-back bending and lifting is dangerous.
Research funding: R.C. Krug received a Master’s scholarship from the Coordination for the Improvement of Higher Education Personnel (CAPES).
Author contributions: All the authors have made substantial contributions to the study: (1) the conception and design of the study (RCK, JPC, MFS), acquisition (RCK, RA, ISP), analysis and interpretation of data (RCK, JPC, OVL), (2) drafting the manuscript or revising it critically for important intellectual content (RCK, JPC, OVL, MFS, POS).
Competing interests: R.C. Krug, J.P. Caneiro and Peter O’Sullivan deliver educational workshops on patient-centred care for the management of pain. All the other authors declare no conflict of interest.
Informed consent: Participants were asked for their informed consent, and were informed that they could withdraw from the study at any time.
Ethical approval: This project was approved by the Research Ethics Committee from the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil, approval number 3.458.845/CAEE 03952718.0.0000.5345.
|History of LBP group||BSBthermometer||r||0.276*||−0.263*||−0.253|
|Current LBP group||BSBthermometer||r||0.197||−0.394*||−0.295*|
r values are Spearman’s correlation coefficient; 95% CI, 95% confidence interval; BSBthermometer, Bending Safety Belief; TSK, Tampa Scale of Kinesiophobia; Back-PAQ-Br, Back Pain Attitudes Questionnaire – Brazilian version; Back-PAQ-BrDanger, Subscale of Back-PAQ-Br; *Correlation is significant at the 0.05 level (2-tailed). **Correlation is significant at the 0.01 level (2-tailed). Correlation criteria (r values): very weak: 0.00–0.30; weak: 0.31–0.50; moderate: 0.51–0.70; strong: 0.71–0.90; very strong: greater than 0.90 .
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